FALL PREVENTION STRATEGIES AT A LEVEL 1 TRAUMA CENTER George M Testerman MD FACS Kingsport, Tennessee Disclosure Statement of Financial Interest I, (George M Testerman), DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation. Disclosure Statement of Unapproved/Investigative Use I, ( George M Testerman), DO NOT anticipate discussing the unapproved/investigative use of a commercial product/device during this activity or presentation. 1
Dr. George Testerman Dr. Tiffany Lasky Dr. Cory Siffring Dr. Dan Anderson Dr. John Beatty Level I Trauma Center: 28 years of saving lives In 2013 we will celebrated 25 years as a Level I Trauma Center 4 Fall-Related Injury Falls >> Among Top 7 Causes of Injury and Death Motor Vehicles Poisoning Falls Choking Drowning Fires & Burns Emergency Preparedness Falls > What are the Risks? Americans living longer, more active adults 65 and older at risk for falls Injuries from falls > limited activity reduced mobility loss of fitness fear of falling >> increase risk of additional injury. 2
Risk Factors for Falls Among Elderly Persons Living in the Community sedative use ** most common!! cognitive impairment disability lower extremities abnormalities of balance and gait foot problems Falls - Related Trauma Facts Falls >> leading cause of injury-related death for adults age 65 and older falls >> most common causes of traumatic brain injury. 29,500 people died from falls in 2013 vast majority over age 65. Falls > Centers for Disease Control and Prevention: One in three older adults falls each year 2.5 million nonfatal falls treated in ER 25,500 older adults died from falls 250,000 hip fractures every year > 95% from falls 3
The Good News!! Falls are preventable!! aging, itself, does not cause falls. muscle weakness, medications >> dizziness improper footwear, impaired vision, slick floors, poor lighting, loose rugs Can be improved!! Home Assessment and Modifications Remove clutter might cause someone to trip Arrange or remove furniture Secure carpets to the floor Wipe up spills immediately Make sure outdoor areas are well lit Home Assessment and Modifications Install grab bars in the tub, shower and near the toilet Install railings on both sides of stairs Provide adequate lighting in every room and stairway Place nightlights in kitchen, bath and hallways Cane or walker to aid in stability 4
Tai Chi, Anyone? Value of exercise >> improves balance muscle tone Hip Fractures Falls Falls >> leading cause of Hip Fractures and Head Traumas. Cost of Fall Injuries in Older Persons 5
Fear of Falls older adults afraid of falling limit their activity decreases their quality of life Economic Costs of Falls 70% of costs Medicare and Medicaid. 40% patients in nursing home had recent fall. Costs for fall injuries higher for women Falls and Death Rates in the US 6
Fall Deaths in Sullivan County TN Elderly Arthritis and Falls Falls and Traumatic Brain Injury Among Older Adults one-third of all (TBIs) traumatic brain injuries 60% of all TBIs older 65 years 75 years > highest rates of TBI-related hospitalization and death 7
TBI Brain Injury C-2 Spinal Fracture Evaluation and Diagnosis of Mild TBI pre-existing dementia or cognitive disorders significant mechanism or evidence of head injury balance impairment, depression, and cognitive deficits 8
Elderly Patients Fall not witnessed by anyone frequent use of anticoagulants for comorbid conditions increased risk of hemorrhage vague neurological complaints Initial Assessment of Brain Injury and Indications for Imaging patient stabilization and the prevention of secondary complications Increased intracranial pressure due to bleeding or edema can lead to cerebral anoxia or infarct Imaging for Brain Injury CT Scan 9
Imaging - Head CT Scan Loss of consciousness Neurological deficit GCS score less than 15 coagulopathy mechanism of injury Rehabilitation of Elderly Patients with TBI cognitive impairment, fatigue, vestibular disequilibrium, sleep-wake cycle changes psychiatric and behavioral disturbances headaches, and vision and hearing changes More Severe TBI Symptoms weakness, muscle spasticity, dysphagia, agitation, and combativeness cerebral infarct hydrocephalus injuries from additional falls. 10
Management of symptoms following TBI tricyclic antidepressants >> complications elderly patients with TBI >> benzodiazepines and typical antipsychotics such as haloperidol should be avoided >> impair recovery from TBI Budgetary constraints in hospitals and nursing facilities potentially harmful sedatives behavior control patient restraints, ethical concerns hospital sitters, who stay with patients and can help to keep them calm, staffing shortages facility visitation policies Fall Prevention repeat fall can be disastrous. reducing polypharmacy physical weakness, coordination impairment, or vestibular dysfunction appropriately tailored physical therapy program Home assessment and modifications 11
Acute inpatient rehabilitation facilities physical therapy occupational therapy speech therapy, rehabilitation nursing, and neuropsychological services 12
Changes in Medicare Reimbursement stricter admission standards for acute inpatient rehabilitation facilities reducing length of stay discharging patients home from the acute inpatient rehabilitation setting. Dementia, Chronic Traumatic Encephalopathy, and Chronic Sequelae of TBI prior brain injury is a risk factor for dementia elderly individuals may be more susceptible to the sequelae of mild brain injury?? Mechanism of chronic cognitive decline whether brain injury initiates a neurodegenerative process or neuronal loss from the initial injury diminishes cognitive reserve 13
Neuropathological Features Deposition of tau protein neurofibrillary tangles, amyloid beta, and TAR DNA-binding protein 43 Neuropsychological Testing Cog Eval useful for clinical decision making, planning, and monitoring of treatment effects. predicting occupational and psychosocial outcomes following a concussion driving ability and activities of daily living repeat testing after 6 12 months Neuropsychological Testing Cog Eval identifying cognitive impairments identifying psych / depression / anxiety Psychotherapy, counseling psychopharmacological treatments 14
Surgeon Creates Fund To Promote Community Safety As Holston Valley's Level I Trauma Center Turns 25 Years Old purchase of improved safety equipment for local high school sports teams safety classes for senior citizens training for teenage drivers- simulator prescription drug abuse battle. Stepping On Fall Injury Prevention Program at Baysmont Injury Prevention at Baysmont Independent Living Facility 15
Senior Center Kingsport Stepping On Fall Prevention Senior Center Fall Prevention John Murnane Instructing Balance and Strength Exercises at Baysmont 16
Ray Side Stepping Exercises for Balance John and Ray Stepping On Class Mock Crash Demonstration at Twin Springs VA School 17
Crash Extrication Demo Crash Victim at school Titans for Safe Driving 18
School students observe trauma demo Conclusions Falls most common cause of TBI multidisciplinary treatment approach appropriate care gives functional independence discharge back to the community. Ongoing research important Thanks! Questions? 19